Radiological Features of Gastrointestinal Lymphoma

Abstract

Gastrointestinal lymphomas represent 5-20% of extranodal lymphomas and mainly occur in the stomach and small intestine. Clinical findings are not specific, thus often determining a delay in the diagnosis. Imaging features at conventional and cross-sectional imaging must be known by the radiologist since he/she plays a pivotal role in the diagnosis and disease assessment, thus assisting in the choice of the optimal treatment to patients. This review focuses on the wide variety of imaging presentation of esophageal, gastric, and small and large bowel lymphoma presenting their main imaging appearances at conventional and cross-sectional imaging, mainly focusing on computed tomography and magnetic resonance, helping in the choice of the best imaging technique for the disease characterization and assessment and the recognition of potential complications.

Figure 1

Abdominal CT scan in a 48-year-old female with gastric lymphoma. Axial pre- (a) and postcontrastographic CT scan in the arterial (b) and portal venous (c) phase show diffuse segmental (length: 9 cm) wall thickening (thickness: 1,8 cm) (arrows) of the gastric corpus and antrum with mild contrast enhancement. The patient underwent gastrectomy with ileal-jejunum anastomosis.

Figure 2

Abdominal CT scan in a 46-year-old male with celiac disease who developed an ileal lymphoma. Abdominal CT scan in the precontrastographic phase ((a) and (b)) and in the postcontrastographic phase ((c) and (d)) shows diffuse segmental (length: 8 cm) wall thickening (thickness: 1,5 cm) (arrows) with mild contrast enhancement in an ileal loop. Multiple subcentimetric lymph nodes are detected near the affected loop in the mesenteric fat.

Figure 3

Abdominal MR enterography in the same patient of Figure 2. MR enterography shows the presence of a circumferential thickening of an ileal bowel loop (arrows) in the coronal (a), sagittal (b), and axial ((c) and (d)) planes, before contrast medium injection. Compared to the coronal precontrastographic phase (e), this thickening shows mild contrast enhancement in the arterial (f) and portal venous phase (g) (arrowheads).

Figure 4

Aneurismatic jejunal lymphoma in a 43-year-old female. (a, b, c) Precontrastographic and postcontrastographic axial CT scan show severe circumferential wall thickening (thickening 17 mm), inhomogeneously hyperdense after contrast medium injection, of a jejunal ileal loop (length: 20 cm) located in the left side and left upper quadrant (red circle). Moreover, endoluminal dilatation and air-fluid level inside and enlarged lymph nodes and the surrounding mesenteric fat can be noticed (arrowheads). (d) Infiltration of the left colonic and sigmoid bowel wall (arrow). (e) Thickened bowel walls are entwined with a newly formed lymphomatous mass of the left abdominal wall that infiltrates the left abdominal wall muscles and the superior edge of the left iliac muscle.

Figure 5

Abdominal CT scan of ileal and sigmoid lymphoma in a 78-year-old male. Axial CT scan in the portal venous phase shows a non-Hodgkin lymphoma seen as abnormal circumferential bowel thickening of the sigmoid colon ((a) arrow) and of the last ileal loop ((b) and (c) arrowheads). Enhanced lymphomatous small bowel loops (b) represent the halves of a sandwich, enveloping enhanced vessels (the sandwich filling). The patient underwent chemotherapy with marked reduction of the thickening at the follow-up CT scan.